August 28, 2009

Xi'an, China

Terracotta Warriors

It's not all that easy to get to Xi'an, in the heart of China, when you are in Beijing or Shanghai, but since we have a day, we are off to see one of the great wonders of the world - one that man built 2,300 years ago but just discovered during my adult lifetime.

Situated geographically in north central China, Xi'an is ranked among the great historic centers of the world. From its early role in Chinese civilization as the center for the first empire from which "Qin" (I pronounce "chin") gave the West the concept of "China," this gateway to the fabled Silk Road also was the largest and most cosmopolitan city on earth during the golden ages of the Han and the Tang.

My geography of China is pretty basic but the way I think of it on the map is that the borders of China are the silhouette of a rooster - the head to the right and the tail to the left with two feet extending below. The two feet are the islands of Taiwan and Hainan. Beijing is located in the throat of the rooster and Xi'an is the heart. China has had a total of 19 dynasties (I think). Xi'an served as the capital of China for 1,100 years; it has been a city for 3,100 years. The four main dynasties while it was the capital, and probably the most significant four of all since they were so fundamental to establishing Chinese culture was the Zhou (I pronounce "Joe"), the Qin (the ‘chin"), the Han (the "hand") and the Tang (the "tongue") dynasties - sorry but this is the only way I can remember the names and come close to pronouncing them.

We spent the day in Xi'an, the whole purpose of which was to visit the famed terracotta warriors, one of the true wonders of the world. What amazes me is that this stunning archeological find occurred the same year I graduated from college. (What will be found next?). The buried army of Qin Shi Huangdi is one of the largest and most stunning archaeological finds of the 20th century. Discovered in 1974 by a farmer (farmer Young - we actually met one of the other 4 "founding" or "discovering farmers" at the museum), the warriors and horses have earned the distinction of being one of the Wonders of the World, deservedly so. The full-size terracotta army (so far over 1,000 have been excavated - of an estimated 8,000 that are believed to exist at the site) testify to the imagination and ingenuity of man and his commitment to be protected in afterlife. What you see when you visit is three buildings (one the size o fan aircraft hangar) that have been constructed over the sites that are being excavated - you see a stunning display of life-size sculptured warriors and horses. Pretty unbelievable and hard to describe.

The emperor had constructed an army of warriors to protect him in the afterlife. We were told 720,000 people spent 38 years constructing the 8,000 terracotta soldiers and horses. At the end of the project, all of the workers were sacrificed (killed) o that no one would know of the project - mass graves were found later. The terracotta soldiers were left as standing armies in large pits, with a ceiling constructed above them, and then 20 meters of earth placed on the ceiling (all beneath ground level) to hide the entire operation under the farmland That is why it took 2,300 years to find them. These warriors with their horses stand in these pits in battle-ready position, fully armed, battalion after battalion over several acres. At the time of the discovery back in 1974 Newsweek magazine described the eerie and monumental find as "the clay clones of an 8,000 man army."

That's as well as I can do describing the site. Karyn and Bryan and the rest all loved it. Add it to your bucket list.

Now we are off to Hong Kong.


Commentary: Ted Kennedy's death a loss for mankind

By Bill Frist
Special to CNN

Editor's note: Bill Frist is the former Republican majority leader of the U.S. Senate and a professor of medicine and business at Vanderbilt University.

(CNN) -- The telephone rang in the deep hours of a dark night after a heavy day for our family.

My mother, affectionately known as Dodie, had passed away just a few hours after my father had passed, the two dying of independent causes.

The call -- the first that my wife, Karyn, and I had received from any of our friends or Senate colleagues -- was from Ted and Vicki Kennedy. That is caring and that is love.

Imagine being in Nantucket with your non-sailing sons with Ted, the master of the sea, skippering his beloved wooden sailboat over from Hyannis, asking the boys to jump aboard so he could take them on a harbor cruise and tell them a bit about why his brother John so dearly loved the United States of America.

He focused time and energy on the young and the importance their lives will play in meeting the challenges of today and tomorrow.

You see, in our lives Ted Kennedy was more than the legislative lion of the Senate.

He was the young senator I first met as a college intern in 1972 as he patiently found the time to lay out the fundamentals of universal health care to our summer class.

He was the proud stepdad who with Vicki beat Karyn and me to every afternoon high school baseball game while our sons played side by side.

And he was the masterful legislative colleague who never sacrificed his liberal principles standing for the everyday person as we joined each other on the health committee as respective co-chairmen to write and pass bills on health care disparities among the poor, emerging infectious diseases such as HIV and avian flu, and preparing the nation and the world to fight bioterrorism.

His death is a loss not just for Massachusetts and the Senate, but for all of mankind.

The opinions expressed in this commentary are solely those of Bill Frist.

From Big Kenny Interview: The First Trip -- Impressions of Akon, SUDAN 2007

Love Everybody has helped with the facilitation of the Konyok School for Girls in Akon, Sudan. The school currently has 550+ students enrolled. Love Everybody's goal is to instill hope, strength, and excellence to all students who attend so they can prosper in life. Their motto: "Highlight the good, inspire greatness, and encourage mutual responsibility for the betterment of humankind. -- Love Everybody." Member of the Tennessee Global Health Coalition.

August 26, 2009

So, two years ago; October of 2007, my wife and I and several friends from the organization My Sister's Keeper from Boston and Dr. David Marks and Walt Ratterman from Sun Energy Power decided we were going to get together and go into the country of Sudan.  We went there and visited this village, which is basically a refugee camp right in southern Sudan, about 50 kilometers from the line of demarcation between there and Darfur.  So this is an area that people had fled into that had been pushed off of their land.  Like farmers.  My dad's a farmer, and I guess that's why it hits with me. 

They'd just been pushed off their land that they had fought for over a half a century.  This thing's been going on in Sudan since 1956, a full on by God civil war.  And then in 2005, the south of Sudan and the north entered into what was called the CPA, or the Comprehensive Peace Agreement, which was mentored and led by the U.S.  It's a good thing.  And they've been trying to keep that peace, and that's when the north started trying to push against the west of Sudan and push all the Darfurians out also.

And it's crazy to think that a person that lives over there and a person that lives over here, that there's any difference between them and that they shouldn't respect each other.  And so we decided after seeing this and going and visiting this village that Dr. Gloria Hammond from Boston had originally told me about.  I met her here in Nashville at an event where she was speaking, and she told me about the people in Akon and how we were both in this conundrum: there's a war going on where these people are being tormented and hurt so bad.  But you know, I'm a musician.  I can't go into a war zone.  She's a minister and a "nun", a sister and a doctor and an educator.  You don't put women in a war zone.  But get as close as you can to it and shine as bright of a light as you can possibly shine, and all that other stuff just has to go away, or at least stand on the sidelines and chill out for a while and see what happens when three, four, five, six, seven, eight, 900, 1000 girls are meeting underneath of a tree to get educated, to get an education, because they know that they can rise up and lead their people and lead their country and there can be peace.  And they can be friends with everybody, everywhere, and make music.

At the same time, you know, we got do what I call "due diligence."  I went in to make sure that the people that I had met and had organized with on the ground were really doing what they told me they were doing cause I didn't want to go; you know, I've worked real hard to get what I had, and I didn't want to blow it, you know, and end up being in some corrupt system somewhere where people are just pulling off the top. To me, it's easy enough to grow food and provide for your family.  You know, when you're going to step outside of that to try to take care of some other things, that's when it can get real tough.  But you know, if you use your noggin a little bit, go check it out, do your due diligence. 

Well, that's what we did.  We went in there, checked it out, and did our due diligence. So then, I mean, just so many amazing things happened.  The first plane we flew on, the cowling came off the left engine, and it was pulling that plane hard left.  Fortunately, we'd only been up in the air about 15 minutes, so we were able to circle back around, and there was another runway just outside of Nairobi at Wilson Airport.  We landed there, and ended up the only plane that we could get was a bigger plane, and they had to give it to us for the same price.  So we were able to carry in all the crates and all the people that we were carrying then, plus we picked up 300 refugee survival kits.  These are people who have been burned out of their homes, and this is enough to keep them alive for a little while until they can get somewhere or get to a village and get their feet back under them.

We flew to Akon. Dr. Marks saw about 300 patients in two days.  About a third of the people had malaria at that point, so he was just delving out all these pharmaceuticals that we had brought over with us in 21 cases that we carried through airports. 

So we move forward a couple years.  We go back there this year, right where I saw people take those refugee kits and start to establish themselves. Here's a doctor's clinic over here.  Here's a runway right here.  Something's got to keep happening here.  And kind of right in between them there's now a little village that exists, when there was nothing when we went there the first time.

At least I've got you up to now now.

More to come...

Wednesday, August 26, 2009

11 am


             Met this morning with the Minister of Health. The last time I was at the ministry we met just down the hall from the minister's office.  That was in 2003, and SARS had struck just the month before.  Allegedly the Chinese government has hidden the problem from its people and the world, but as the outbreak grew, the news exploded, and no longer could the government contain the news.  I was openly critical that day in our public meeting, representing the U.S. and world opinion.  Though my remarks had nothing directly to do with what was about to occur, the minister just hours later was summarily fired, a sign of recognition that China would officially change its secretive policy of minimizing the ongoing impact of SARS.  And the epidemic rapidly spread throughout China, Asia, and Canada, paralyzing travel and tourism, killing hundreds, and greatly diminishing economic growth for the next year of Asia and Canada.

             That was just 6 years ago.  Wow, things have changed.  Today, the Minister met with me, my son Bryan, brother Tom and Chuck Elcan and Henry Zhou.  Though one of the main purposes of the meeting was to discuss how we as a government and we in the U.S. private sector could work with the Chinese government and their private sector to address the health challenges the Chinese people are experiencing today, I in particular wanted to get a full understanding of what China was doing in their major domestic reform efforts announced in April.

             Before outlining what I learned, I should point out that being a doctor in China is not very remunerative.   In a web-poll conducted by, 75 percent of the 2,183 doctors surveyed earned an annual salary of less than 40,000 Yuan ($5,883).  These data and much of the content of the discussion below were gleaned from my conversation with Elizabeth F. Yuan, R.Ph. who is the Health and Human Services attaché to the Embassy.  Her discussion at the U.S. embassy yesterday combined with the discussion today with the Minister of Health are the background for the following summary of health reform in China as it stands today.

             China's blueprint for healthcare reform was released on April 6 and has been heavily promoted by the official Chinese media.  My interviews and interactions over the past two days with health experts in Beijing, visiting infectious disease hospitals and doctors, talking last night to local Chinese businessmen, interviewing our ambassador and health experts a the embassy agave me a tremendous opportunity to leave behind for a few days all of the reform discussions in the U.S. and to see how another emerging country is approaching health care reform on a massive scale.  I wrote this today, but over then next several days of discussions I may well modify these observations.

              The overall scheme aims for universal healthcare coverage by 2020.  In the initial 2009-2011 phase, China intends to invest $124 billion in five broad reform areas: 1) basic healthcare insurance, 2) a national essential medicines program, 3) improvement of the rural health care service network, 4) elimination of the gap between urban and rural healthcare, 5) and continuation of public hospital pilot projects.

             The 5 areas parallel much of what we have and are attempting to do in the U.S.  We are shooting in the U.S. for universal coverage overnight (and won't get true universal coverage for another 5-10 years, I predict).  We in the U.S. did the national drug program (2) when I was Majority Leader. And in our major health bills like the bill we passed in 2003 and the Obama bill which will pass in November, there will be a number of significant pilot or experimental projects which importantly will allow some determination of what works and what does not before a proposal is adopted nationally (too risky - I am a big believer in these pilot projects!).

             One of the things we are seeing in the U.S. is reform from Washington being dictated at the federal level, but in the end (as feared by many governors) much of the cost of universal care and reform will fall to the states.  Governors ask, where is the money going to come from (for example the potential doubling of Medicaid under the Obama plan is funded more than 50% by the states - but where are they going to get it? - obviously taxes will have to go up on everyone).  Similarly in China about 60% of the proposed reform spending will be paid for by the provinces, though their reform is mandated by the central government and communist party.  How are the poor provinces going to come up with the money?   Thus, will the ambitious reform really ever take place?  The parallels with what is happening in the US with a paternalistic government mandating huge spending at a time of recession and an obvious inability to pay for it are striking.

            The following is only for the policy wonks and much too much detail for the average reader.  But I love this stuff (and it leads to greater understanding of overall health reform globally and domestically):

            The key features of the announced plan include the following:

`           1.   Government support for the construction of 2,000 county-level hospitals and thousands of urban community clinics;

            2.   Training sessions for village and township medical clinics and urban community medical centers. Specifically, China hopes to train 360,000 health care professionals for township health centers (this seems like an impossible goal to me but at least they are shooting for the sky.  And what I am finding on the ground is not an absence of facilities or even pretty good equipment but an absence of trained human healthcare capital (i.e., people).

            3.   160,000 for urban community health institutions in three years;

            4.   Coverage of 90 percent of rural and urban residents with basic medical insurance by 2011.  By 2010, subsidies to the Urban Residents' basic medical insurance (URBMI) and the New Rural Cooperative Medical Scheme (NCRMS) will be increased to RMB 120 (US$17.60) per person per year.  The maximum amount payable by the Urban Employees' Basic Medical Insurance (UEBMI) and URBMI will be increased to six times the annual average salary of local employees and disposable income of urban residents.  The maximum amount of the NRCMS will be increased to over six times per-capita net income of local farmers. (The importance of the expansion of the social insurance program is much more important that what I initially thought.  Why?  Because the Chinese people, today without much in the way of social insurance, keep saving knowing that someday they will need it for health;  this excessive savings means that they don't spend today, which is clearly needed not just in times like today but in all cases of growing economies).

            5.  A list of national essential medicines was released in August 2009.    It consists of 205 chemical and biological drugs and 102 traditional Chinese medicines.  This is a big deal because supposedly the Chinese people will have success to these in the public hospitals (98% of hospitals are public).

            6.  Increasing government regulation of medical services and prescribing practices to avoid over-prescription to fund hospital operations.  ((This was also surprising to me.  About 50% of hospital budgets come from the charges associated with excessive prescribing of medicines.  Hospitals literally operate on the profits they receive from the medicines they prescribe and dispense.  That is all over the country.  My obvious question was, "If you close this source of hospital revenue, what will replace it?  How will these hospitals stay open?)) The Implementation Plan includes wording to increase public disclosure of hospital budget, expenditure, and revenue management information.

            7.  The Government's plan calls for continued pilot projects to reform public hospitals.  In the key area of hospital funding, which underlies the problem of relying on drug sales and expensive diagnostic techniques, the plan calls for gradual changes to service charges, drug sales, and fiscal subsidies.  The goal is to make service charges and fiscal subsidies the primary channels for funding public hospitals.

            I can't wait until the business and medicine course I teach at Vanderbilt begins this year because I want them to look at the following argument and see what they think on the relationship among this plan, rural consumption, and rebalancing: In the official media, Chinese academics argue that increased healthcare expenditures under the plan will help reduce precautionary savings, thus increasing domestic consumption, helping to rebalance the economy to rely less on exports and investment.  Official media reports that the plan will help reverse the trend in who bears the burden of medical costs, in which the share of personal spending on medical services has doubled from 21.2 percent in 1980 to 45.2 percent in 2007, while Chinese Government funding has dropped from 36.2 percent in 1980 to 20.3 percent.  (Note: This data is based on official records.  Because many doctors and hospital fees are paid covertly in 'red envelopes' (gratuities) directly by the patient, the proportion of private medical expenditures are likely even greater.  In my discussions with a broad range of people I estimate that private out-of-pocket medical spending is probably 60% of all spending.

             Again, I want to thank Elizabeth F. Yuan at the American Embassy for explaining so much of this to me yesterday after I met with Ambassador Jon Huntsman  Our embassies do a remarkable job.  I also wish to thank the Minster of health in china who so generously gave of his morning today.  I have much more to learn.


August 26,2009

Today Karyn and I feel the deep loss of a personal friend.  In our lives Ted Kennedy was more than the legislative lion of the Senate.  He was the proud sailor who introduced our sons to the spiritual element of sailing on his beloved wooden sailboat in Nantucket, the young senator I first met as a college intern in 1972 as he patiently found the time to lay out the fundamentals of universal health care to our summer class,  the proud step-dad who with Vicki beat Karyn and me to every afternoon high school baseball game while our sons played side by side, and the masterful legislative colleague who never sacrificed his liberal principles standing for the everyday person as we joined  each other on the health committee in writing and passing bills on health care disparities among the poor, emerging infectious diseases like HIV and avian flu, and preparing the nation and the world to fight bioterrorism.    His death is a loss not just for Massachusetts and the Senate, but for all of mankind.   

 --Senator William H. Frist, M.D.

As much as I hate to say it, my time in South Africa has now come and gone. Calandra Miller and I safely arrived back on American soil at 7:30 AM on August 6, 2009. At the time, I could not say the same for our luggage, which remained (safely) in Johannesburg, South Africa.

The last couple of weeks spent in South Africa were bittersweet, to say the least. I was looking forward to coming home and seeing my family and friends once again, but at the same time I was having to say goodbye to many good friends and, what I consider to be, family back in South Africa. The volunteer girls, Betty, Eva, and Engelinah treated us to some milkshakes as a going away present. This was a distinct honor to me, because what we might take for granted in the United States, they had to budget for weeks in advance. We also spent some time celebrating with Stefan and his family, the Wiids (the family who hosted me in their cottage during my stay in SA), and Pastor Dave Garton and his wife Gail (who run the rehab program that Project HOPE is partnering with). In the midst of our imminent departure, I took some time to reflect on what I was doing and had done since arriving in South Africa.

My purpose for being in South Africa was to assist in the fledgling steps of a promising program targeted towards orphans and other vulnerable children. Calandra and I had the distinct privilege to contribute our work to laying the foundation on which this program could get started. Much of this consisted of doing what many would consider mundane: data collection. Day in and day out we went door to door asking the same questions for our rapid needs assessment. After all was said and done, we had a grand total of 185 caregiver surveys and 266 parenting maps for children. This data has since been used by Project HOPE for grant proposal writing and other fund raising endeavors. All of our labors brings to mind a famous quote from Dr. Irving J. Selikoff, "Statistics are human beings with the tears wiped away." I can now whole-heartedly attest first hand to this, and with nearly every interview was reminded of why I was there.

My translator and I entered into a dimly lit home constructed entirely of sheet metal where we found a frail middle-aged woman crouched down washing the red clay dust off some furniture in her small room. She was obviously ill, and barely had the strength to stand and greet us with the customary handshake. Yet, when asked to take part in our survey she eagerly agreed and carefully sat down on the edge of her bed. Throughout the entire interview the woman provided responses through restrained whimpers and sobs. The questions I asked were simple, non-intrusive, and were not targeted toward specific health conditions. I could only assume it was due to her being overwhelmed with her health and living conditions. At the conclusion of our interview, she pleaded for any help we could give her, but all I could do was offer her a hug and a promise of my prayers, which she gratefully accepted. For many, the only hope they have is their faith in God to deliver them from their squalid conditions.

While walking through the dusty, debris ridden streets of the Zenzele settlement with Betty as my translator, I saw three men sitting on buckets in front of their home singing a song. I didn't think much of it, and continued on to the next person's home to conduct another survey. About 20-30 minutes later, we emerged to these same three men singing the same song. I asked Betty what they were singing out of curiosity. "God have mercy on us," she said.

Unfortunately, many of these people will not find much refuge from the currently overwhelmed healthcare system in South Africa. Residents of these settlements have told us that healthcare providers will often mistreat or even completely overlook them when it is discovered that they are not native South Africans. This is only exacerbated by the physician strikes taking place all around the country due to poor salaries and working conditions.

This is not by any means encouraging for a woman who volunteered for a field test of the Munsieville Survey Calandra and I had designed for Project HOPE. She was 23 years old, and spoke English well enough for me to conduct most of the survey without Betty's help. Within this survey were much more detail oriented and intrusive questions, including those that asked about sexual behavior. After completing the field test, Betty and I struck up a conversation with this woman to discuss the strengths and weaknesses of the survey. When I least expected it, she volunteered to us some extremely sensitive information that she would only entrust to her closest friends and family. She had AIDS. On top of this, she also told us that she had recently been diagnosed with breast cancer in her left breast (which she reported only having pain medications for). Her live-in boyfriend and sole bread winner for the family (making about R800 per month, or around $100 U.S.) also had AIDS. While he was at work, she was responsible for raising their young 2 year old child in the small shack they called home. I was deeply honored by her telling this to us. It was as though she trusted us, as representatives of East Tennessee State University, Project HOPE, and Hope Through Healing Hands, like we were family. She understood that we were there to help and wanted to change the conditions that they lived in for the better.

Even though she was just one year younger than myself, I couldn't help but think about her as a child no more than 10 years ago. There was no one around to teach her safe sexual practices, or to help her get a proper South African identification card. There were no concerted efforts to give her the proper education she needed to become an empowered woman and begin the climb out of poverty's grasp. Then it struck me. This is why Calandra and I are here. This is the spirit of public health, to prevent terrible outcomes like this regardless of where they come from or what gender they are. Though her story was transformed into categorical and continuous variables in a database, her story, in conjunction with many others, will be used in research by Project HOPE and its partnering organizations to help prevent suffering like this for future generations.

I feel honored to have taken part in Project HOPE's endeavors in South Africa. Without Hope Through Healing Hands and the Frist Global Health Leaders Program, it would not have been possible for me to contribute to this great cause. Through this experience, I have gained tremendous into what it is like to operate a health campaign in a foreign country, something that I plan to pursue professionally when I am finished with my formal education. I am forever grateful for having this opportunity, and will carry what I have learned from this experience for the rest of my life.

August 24, 2009


Today, after meeting all day with health reformers in China, it is clear that partnerships with U.S. academic institutions are important to build capacity and institutional support here. 


At Peking University, Dr. Ke Yang, Executive Vice President of Peking University (PKU), enthusiastically described the great results of a Duke-Peking University two-week global health diploma program with the School of Public Health.


By email, my friend and global leader at Duke University’s Global Health Institute, Mike Merson, M.D. also told me of Duke's training program in cardiovascular disease at Peking University Health Sciences Center and their partnership in a new Center of Excellence in Cardiovascular Disease Research led by Yengfeng Wu, M.D., Ph.D. that is based at The Georges Institute in Sydney, Australia.


And at Vanderbilt University’s Institute for Global Health, global health leader Sten Vermund, M.D., Ph.D. tells me Vanderbilt has a twelve year partnership with two sides of the Ministry of Health for training, the Foreign Loan Office and National Center for AIDS.  They have strong research ties in Guangxi, Xinjiang, and Yunnan Provinces (one large ongoing study in the former two provinces). Also, they have a special partnership on rural health management training that Governor Bredesen and Commissioner Matt Kisber have co-initiated and sponsored.  In fact, there are other VU links to China (history, business, education, etc) including the partnerships between Fudan University and VU as "peer partner institutions."


Frist Visits Ditan Hospital, Peking University, and Tennessee-China Development Center

August 23, 2009

Frist visited the Beijing Ditan Hospital which was the center for dealing with the SARS virus in 2003. Today, it has been refurbished to hold 500 beds. It is now designated as the H1N1 Hospital for China.

Frist visits with nurses inside Beijing Ditan Hospital. They are demonstrating how their PDA is monitoring H1N1 patients. The Senator notes that it is one of the most electronically integrated hospitals he's ever visited.

Frist meets with Vice President of Peking University. Peking University has eight hospitals and health science schools. There, he discussed health care reforms underway and how American health care companies can assist in improving health care in China today.

Senator Frist, Tommy Frist, and Chuck Elcan visit Tennessee China Development Center.









Sunday, August 23, 2009

9 pm, Beijing

In 2003, representing the U.S. Senate I met with President Hu Jintao, CMC Chairman Jiang Zemin, Premier Wen Jiabao, and the Foreign Minister and Health Minister. One evening there was a majestic dinner in our delegation's honor, similar to our State dinners, hosted by the NPC Chairman Wu Bangguo (who I understand is coming to DC in a couple of weeks). It was the height of the SARS crisis and China had been shut down. I remember so vividly the discussion we had in the Ambassador's residence in Japan (the country visited just prior to our planed trip to China) when I gathered all the Senators around to make a final decision of whether to enter China at a time of some risk. We decided to go ... to demonstrate our support of the Chinese government in those difficult times as it did its best to fight the new, frightening and deadly SARS virus.

I am reminded of all this as I enter China today and read the China Daily headlines in the airport, "H1N1 will endanger more lives," with a subtitle "Up to 2 Billion may be infected; China will see rise in cases this winter." The article goes on in the first few paragraphs to say that the number of H1N1 cases will double every three or four days until they reach the peak transmission period.

The world is a small place. SARS tore out of China and invaded Canada. The affected economies grounded to a halt. Similarly HINI will be a worldwide pandemic. There are no borders to these cagey and fatal viruses. We are all in this together and our response must be mutually dependent. We are one. There is no separation of global health from domestic health when it comes to these emerging diseases.

August 22, 2009

Frist Update and Expectations: Written on the plane to Shanghai

Just getting used to the new Prius. I am taking a lot of heat from my family who see me more the Tahoe or Suburban type. It was tough trading my 1992 Suburban (my only car) because of the family memories that centered on that car. I had saved some money back in ‘92 by getting a two wheel drive (though I regretted it later when in DC I kept getting stuck in the snow - sometimes doesn't pay to be too cheap); it was the car the boys learned to drive in the narrow streets of Georgetown (side mirrors a little scratched). I resisted this clunker deal initially because I thought it wrong that the taxpayer was buying my new car for me, but after a few days I broke down on the moral argument of mileage, pollution, etc (and the gift of the average taxpayer!!). I always buy my cars from Lee Beaman; his dad and mine were best friends. Christi, who works with me, picked out a great Yukon for me. But I opted for the Prius - why? Because it gets 4 times the gas mileage and I want to reduce gas consumption since so much of the proceeds goes to those who feed terrorism. And it is cheap - we actually ended buying two Pri(i) - one for me and one for my brother Tommy - for the price equal to one Yukon. Still hate to see the Suburban go - and it sounds like they poison it to kill it. Ugh.

Last week Karyn and I were in Nantucket and we hosted an annual clambake for family and friends. Brother Tommy and Trisha come up each year and on Friday night he said that he was going to China in two weeks. "Bill, why don't you and Karyn join us? You know many of the Chinese leaders from your previous Senate trips there; if you were there we could explain what we are doing and what we could potentially do to the central government." You see Tommy and his son-in-law are constructing a hospital that is public-private (government is 70%) in a community about 2 hours south of Shanghai.

Karyn and I had a trip planed to Italy that was to begin on September 1; we hade never vacationed in Italy and it was time for me to take her there since most of our friends at our age that we see day to day have been there multiple times. Our summer vacations have been working and doing surgery in Bangladesh, Mozambique, Uganda, southern Sudan, Darfur, and the Congo. Doing surgery in the bush is a far cry from Florence and Venice and the Amalfi Coast (as I was reminded by Karyn); Italy is the destination this year (and no surgery). No skimping here, I called the famed travel agent Andrew Harper and said just put together the rip for us. Karyn deserves it.

So now 2 weeks before departing to Italy how was I going to get a visa for us to China and then organize a trip there? With a lot of help we did it, and this morning at 3:15am we got up to board Delta to Atlanta and then Atlanta to Shanghai to Beijing. At this point, we have no idea what the plan will be until we see the Minister of Health on Wednesday (today is Saturday in the US).

I am not a China expert, but I am fascinated by the country and when I am advising young people today I tell them to focus on China and figure out some way to go there and live for awhile. The demographics and economic direction are just too clear as we look forward over the next 30 years.

In terms of health, the central government has made a major commitment in funding health services throughout China. And though the "down-side" of central command we all know in America is lack of democratic decision making and transparency, the "up-side" is that once a decision is made there is not a fiddling around to fund and accomplish the result. So with that much boldness directed at solving health inequities and improving health services, coupled with huge investment, I knew I wanted to be in China and get the lay of the land.

We will build the next 8 days around health and healing, be open to opportunities to share our expertise, learn from their culture and approach, and then just see what happens in the future. We're in the information gathering stages ... we are not up to the "conceive it, believe it, do it" phases frequently quoted by my mentor the pioneering heart surgeon Dr. Norman Shumway.

Everyone has a bucket list and we tend to pay more attention to them the older we get. Tommy says Tibet is on his, so the group said let's go. Then we heard that the altitude is 14,000 with no acclimation; I get altitude sickness and he had a minor heart procedure two weeks ago so the doctors said wait 6 months. A relief to me because I know I would be sick. Karyn does well at high altitude (like when we hiked the Virunga Mountains on the order of Rwanda and Uganda looking for the mountain gorillas - at 12,500 feet we eventually found them but I was so hypoxic I don't remember anything we did. Karyn thrived. I should just keep my medical work with the gorillas focused on the National Zoo over in Washington, DC instead of trekking in Rwanda, which was last year's trip - I know ... that is why we are doing Tuscany and Florence!).

So now that Tibet is out, we will do a non-health side trip to Xi'an, China, the ancient walled city, once the capital of China, and often overlooked. It is now known for the unearthed Terracotta Army of Warriors and horses of Emperor Qin Shi Huang. Apparently at night the city becomes the City of Lights and an atmosphere that leans on fantasy. One article describes an 18 course dumpling banquet (at De Fa Chang). That is the extent of what I know about the area now, more to come once Karyn and I figure out to get there.

So what is the kernel behind this trip in the first place? It starts with my oldest brother
Tom Frist who founded and ran Hospital Corporation of America, the largest hospital company in the world, and his son-in-law Chuck Elcan who two years ago set out on building a hospital in partnership with the government in China. The location for the hospital (approvals and funding have been obtained) is the city of Cixi (1.8 million people in immediate area) which is in the Zhejiang Providence. Cixi is directly east of Hangzhou and is a little over 2 hours south of Shanghai (directly across the bay).

So that hospital will be built and staffed and locally run (manages using the systems that have been fine tuned by years of western hospital management expertise). If that works and works well, what would the next step be? Our trip and our meetings with the government will help answer that, so it will be fun sharing my observations with you as we go through all this over the next 8 days. What we do know is that the Chinese government is making an unprecedented and monumental commitment to its health sector; they could use, I would think, some western expertise. This is not a venture of HCA. Luckily the third partner Henry Zhou lives in China and will be our host once we hit the ground.


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